Effects of the SGLT2 Inhibitor Empagliflozin in Patients With Euvolemic and Hypervolemic Hyponatremia

Inclusion criteria

• chronic eu- OR hypervolemic non hyperosmolar (<300 mOsm/kg) hyponatremia (heparin plasma sodium <135 mmol/L on day of inclusion)

Exclusion criteria

• known hypersensitivity or allergy to class of drugs or the investigational product,
• severe symptomatic hyponatremia in need of treatment with 3% NaCl-solution or in need of intensive/intermediate care treatment at time of inclusion
• clinical hypovolemia
• Severe reduction of eGFR <20 mL/min/1,73 m2 (KDIGO G4 and G5) or end stage renal disease
• Chronic liver insufficiency with Child Pugh Score ≥10 or decompensated liver cirrhosis (jaundice, hepatorenal syndrome, encephalopathy, bleeding, …)
• Hepatic impairment defined as aspartate transaminase (AST) or alanine transaminase (ALT) >3x the upper limit of normal (ULN); or total bilirubin >2x ULN at time of enrolment
• uncontrolled hypothyroidism
• uncontrolled adrenal insufficiency
• systolic blood pressure <90mmHg
• contraindication for lowering blood pressure
• diabetes mellitus type 1 or pancreatic diabetes mellitus
• treatment with SGLT2 inhibitors, lithium chloride, vaptans, demeclocycline or urea on inclusion day
• severe immunosuppression (leucocytes <2 G/l)
• peripheral arterial disease stage III-IV of the Fontaine Classification
• fasting or other reasons preventing medication intake
• previous enrolment into the current study
• participation in another intervention study
• pregnancy, breastfeeding, intention to become pregnant during the course of the study or lack of safe contraception.
• end of life care